Ben Mueller, MSKaren Peters, DrPH

Marcela Garcés, MSPHSergio Cristancho, PhD

Empowering Latino Communities to address Health Disparities: A Community Based Participatory Action Research Approach

To promote the health of rural communities To promote the health of rural communities through partnerships in education, service, through partnerships in education, service, research and policyresearch and policy

Presentation OverviewHispanic Health and Health Disparities in Illinois

A Rationale for Community Participatory Action Research

Applying the CBPAR Method to Address Hispanic Health Disparities

Effectiveness of Health Promotion Approaches/Linkages to Social Justice

Overview of the Nuevos Horizontes (NH) Program

Overview of the UIUC NH Media Initiative

Questions, Comments and Discussion

I. History and Roles of Research Team

• Ben Mueller, MS – Extension Specialist, Community Development• 1998, UIUC Extension partnership begins with HRSA funded “Merging Medical

Education and Community Health”, Rural Outreach grant; 2001 NCRHP Asst Dir, Community Outreach

• Karen Peters, DrPH – Assistant Professor, Health Policy & Administration• 2002, Rockford MPH program faculty & NCRHP Asst Dir, Research & Evaluation

• 2003 - NCRHP awarded NIH/NCMHD EXPORT Grant

• Marcela Garces, MD MSPH - EXPORT Community Outreach and Engagement Core Coordinator• 2004, recruited to NCRHP from UIUC to coordinate Outreach efforts

• Sergio Cristancho, PhD – Research Assistant Professor, DFCM• 2005, recruited to NCRHP from UIUC to coordinate research efforts of EXPORT

Community Outreach and Engagement Core

• Note: Team represents 3 U of I campuses

I. Perspectives and Expertise of Research Team

• Research team grounded in Human Rights and Social Justice perspectives

• Discipline Expertise of Research Team• Rural Community and Economic Development and Multi-

media Studies (Mueller)

• Population Health, Community Evaluation and Dissemination Studies (Peters)

• Health Education/Health Promotion Studies (Garces)

• Cross Cultural and Acculturation Studies (Cristancho)

II. Community, Evaluation and Dissemination Research: Definitions

Applied research refers to the use of the scientific method directed toward the generation of new knowledge that addresses issues of social importance

A. Community Research - Applied research using the scientific method emphasizing the solution of social and community problems

B. Evaluation Research - Applied research using the scientific method to assess the worth or effectiveness of an activity, program, or policy

C. Dissemination Research – Applied research using the scientific method to determine how targeted distribution of information/intervention to specific populations can be successfully executed to bring about increased spread of knowledge to achieve greater use and impact

II. Community, Evaluation and Dissemination Research: Frameworks,

Models and Approaches

• Health Disparities Research

• Health Disparity/Equity Frameworks (NIH 2002; DHHS 2000; WHO 1986)

• Vulnerability Model (Shi and Stevens, 2005)

• CBPAR approach (Israel 2003; Fals-Borda 1987; Freire 1982)

• Evidence based practice approach (Brownson 1999; CDC 2001)

• Practice based evidence approach (Green, 2007)

A. Community Research Strategic Objectives

…to address health disparity and promote health equity…

• Identify and engage community partners in the joint conduct of in health-related research to reduce health and health care disparities using evidence-based disease prevention and intervention activities in rural underserved communities in Illinois

• Implement and evaluate a practice based evidence model of community research using a participatory approach that encourages and equips the community in addressing their own health-related priorities

• Build capacity in the community to create and deliver health information that is culturally sensitive and appropriate to needs of rural and underserved populations

• Enhance the abilities of community members and health providers to identify and resolve health and health care disparities

What is Health Disparity?

• Differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions and health states that exist among specific population groups (NIH, 2000)

• Disparity manifests as shorter life expectancy and higher rates of CVD, cancer, infant mortality, birth defects, diabetes, stroke, STD’s and mental illness among others

• Disparity among population groups is also evident at the health care delivery system level, in differential rates of access and use of services

• Equity in health is the absence of systematic disparities in health (or in the major social determinants of health) between groups with different levels of underlying social advantage/disadvantage (e.g. wealth, power, prestige) – Starfield, 2000

Types of Health Disparities

• Health Status AND/OR Health Outcomes

• Individual personal factors – biological/genetic, sociodemographic, socioeconomic, disabilities, residency, cultural norms and values, literacy levels, familial influences, environmental/occupational exposures

• Societal/System factors– Social resource distribution, social and political advantages such as knowledge and social connections, insurance status, transportation/geography, distribution of health resources (clinics, health professionals training and approaches or patterns in providing care)

Population Focus: Rural Hispanics in Illinois

• Rural:• NCRHP mission: to promote the health of rural communities

through partnerships in education, service, research and policy• 84 of 102 IL counties are rural• Known disparities among rural populations in health

status/outcomes and access to services

• Hispanic:• Fastest growing underserved population in US and IL (US and IL

Census, 2000)• NIH interests in research regarding underserved including

racial/ethnic populations• Little known about rural Hispanic immigrant health status/outcomes

and access issues in upper Midwest of US

Hispanics in Illinois

• 1,530,262 Hispanics in Illinois (12.3%); • 1,253,670 of whom are Spanish speakers

• 74.8% Mexican• 11.7% Caribbean• 2.6% Central American• 2.5% South American• 8.4% Other

• 121.5% was the growth rate of Hispanics in Illinois between 1990-2000

Source: IL Census, 2000

Hispanic Health Disparities in IL(Source: BRFSS, CDC, 2007)

Risk Factor/Health Issues Hispanic African American

White

Risk Factor Issues

Hispanics less likely to have had cholesterol checked within last five years 50% 70% 75%

Hispanics less likely to participate in physical activities in past month 59% 70% 77%

Hispanics more likely to be current smokers 21% 16% 20%

Hispanics less likely to consume fruits and vegetables 5 or more times per day

18% 22% 24%

Hispanics less likely to self report health status as ‘Good or Better’ 70% 75% 87%

Health Issues

Hispanics less likely to have been told to have diabetes by physician 6.5% 16.2% 6.8%

Hispanics less likely to have been told to have asthma by physician 8% 17% 12%

Hispanics less likely to have been told to have arthritis by physician 12% 27% 27%

Hispanics less likely to have been told to have high blood pressure by physician

14% 36% 26%

Percent Uninsured 30% 22% 13%

Community and Economic Development Linkages: Vulnerability Model

(Shi and Stevens, 2005)

• In rural communities, health disparities in underserved populations have adverse affects on health care institutions, schools and business

• Negative economic impacts are related to access/navigational issues in the health care system (System)

• Susceptibility to risk factors aligned to cultural background (Individual)

Community and Economic Development Linkages: Vulnerability Model

Vulnerability Model of Perceived Access Barriers for Rural Hispanic Immigrants

Individual and Systems Interaction Model

Individual ModelsHealth insuranceHigh costs of Healthcare servicesCommunicationLegal Status / Documentation and DiscriminationTransportation

Systems ModelsHealth insuranceHigh costs of Healthcare servicesCommunicationLegal Status / Documentation and DiscriminationTransportation

Community Based Participatory Research (CBPR)

• “A partnership approach to research that equitably involves entities such as community members, organizational representatives, and researchers in all aspects of the research process; with all partners contributing their expertise and sharing responsibility and ownership to enhance understanding of a given phenomenon, and to integrate the knowledge gained with action to improve the health and

well-being of community members” (Israel et al., 2003)

Participatory Action Research (PAR)

• “Action-oriented research activity in which ordinary people address common needs arising in their daily lives and, in the process, generate knowledge” (Park, 2001, p.81)

• Roots in Latin America as an epistemological paradigm shift that calls for academics to become more involved with communities in addressing social disparities (Fals-Borda, 1987; Freire, 1982)

Community Based Participatory Action Research (CBPAR)

• PAR• Commitment to social transformation• Origins in Latin America • Focus on oppressed and underserved populations

• CBPR• Commitment to evidence-based scientific rigor• Emphasis on diverse partnership building• Requires resource sharing between academic and community

partners• Grounding in ecological model of health

Partnership Formation: Overview

• Use adaptation of Community Organization and Development Model (Braithwaite, 1994)

• Facilitates development/functioning of coalition boards that are dominated and controlled by the community

• Criteria for choice of communities:

• Significant increase in rates of Hispanic growth

• Presence of community linkage (Extension) expressing interest to engage in CBPAR process

• Geographic distribution across IL

• Diversity of community workforce (e.g. agriculture, low skill manufacturing, services, meat processing)

Overview: Communities Involved

• Beardstown• Belvidere• Carbondale / Cobden• Champaign / Urbana• Danville• DeKalb / Sycamore• Effingham• Galesburg• Monmouth• Rochelle• Rockford

Overview: Hispanic Population Growth (1990-2000) in Counties Involved

County1990

# Hispanic2000

# HispanicNumeric Change Percent Change

Cass 56 1,162 1,106 1975.0%

Union 182 481 299 164.3%

Boone 2,065 5,219 3,154 152.7%

DeKalb 2,329 5,830 3,501 150.3%

Winnebago 7,771 19,206 11,435 147.1%

Warren 207 507 300 144.9%

Ogle 1,379 3,066 1,687 122.3%

Effingham 121 252 131 108.3%

Vermilion 1,405 2,504 1,099 78.2%

Champaign 3,485 5,203 1,718 49.3%

Knox 1,416 1,896 480 33.9%

Jackson 1,082 1,443 361 33.4%

TOTAL 21,498 46,769 AVG GROWTH RATE 263.3%

Partnership Formation of Rural Hispanic Health Advisory Committees

• Formed and supported 10 pilot Hispanic Health Advisory Committees (HHAC) in 12 IL communities

• Stakeholders involved:

• Community Foundations• Community Hospitals• Faith-based Organizations • Health Sector Organizations• Higher Education Organizations• Hispanic Community-based

Organizations • Individual Healthcare Providers• Local Government Organizations

• Non-Hispanic Community-based Organizations

• Private Clinics• Private Sector Organizations• Public Health Departments• Safety-net Providers• School Districts• Social Service Organizations

Assessment Objectives

• Assess rural Illinois Hispanics’ major health concerns and needs in order to identify health disparity issues and help focus prevention efforts

• Disseminate results to:

• Hispanic Health Advisory Committees (HHACs) to help them prioritize local implementation efforts

• Rural practitioners to inform their clinical or public health practice

• Identify information gaps and future research questions

Research Questions

• What are rural Illinois Hispanics’ major…• perceived health concerns?• perceived risk factors?• perceived barriers to access healthcare?• preferred health information seeking strategies?

• How do these aspects vary according to acculturation and other socio-demographic variables?

Assessment StrategiesCounty Assessment strategies

Survey Small Group Discussion

Community Health Forum

Boone n = 93

Cass n = 255

DeKalb n = 239 n = 52

Effingham n = 119

Jackson/ Union n = 80

Knox n = 149

Ogle n = 58 n = 49

Vermilion n = 117

Warren n = 106

Winnebago n = 811 (MHC) n = 35

TOTAL n = 1,854 n = 181 n = 128

Results: Demographics (n= 941)

Assessment summary and conclusions

Converging evidence from survey, focus groups and small group discussions

• Major health concerns • Oral health; CVD; Diabetes; Mental health

• Major access and navigation barriers • Underinsurance; Costs; Limited information about

available services; Language • Preferred health information seeking strategies

• Workshops in Spanish in community settings; Spanish language media

• Significant variations according to Acculturation in some of these aspects were found but need further probes

Implementation Phase:

• Develop a minigrant proposal based on the findings from the Assessment phase

• Problem description (use of assessment results)

• Partnership description

• Proposed activities

• Budget

• Timeline

Rationale and Process of Minigrant Program

• Provision of financial resources to community partners is principle of CBPR methodology (Minkler and Israel, 1999; AHRQ, WKKF National Consensus Conference, 2001)

• Use of minigrant program component is evidence based (HP2010 microgrant program (2000); WKKF Community Initiative (1992); RWJF Medicine Public Health Initiative - CAHP(2000)

• Minigrant review process involves academic-community reviewers in grant review process

• Technical assistance provided to community applicants regarding suggested improvements to grant applications

Community Minigrant Programs Community Minigrant title Minigrant funds Organizations involved

Beardstown “Medical interpretation Training to community members”

EXPORT: $4,500 Date: 8/23/05Minigrantadministrator: Cass County HealthDepartment

Cass County Health Department(CCHD), St.Francis CommunityClinic, Culbertson MemorialHospital, Liberty NazareneChurch, St. Alexius CatholicChurch, Cass/Schuyler UnitUniversity of IL Extension, CargillMeat Solutions, and the LatinoCoalition for Prevention.

Belvidere “Unidos por tu Salud: Series of educational workshops about Diabetes, Nutrition, Asthma and parenting”

EXPORT: $4,500Date: 11/22/2005 Minigrantadministrator:ALERTA (Hispanic CommunityOrganization)

University of Illinois Extension –Boone County, Boone CountyHealth Department, ALERTA, Illinois Migrant Council, ALTECH of Rockford, Inc., IdaPublic Library Rockford HumanServices Department, CommunityUnit School District #100 (LincolnElementary School)

Community Minigrant Programs Community Minigrant title Minigrant funds Organizations involved

Carbondale/Cobden

“Juntos Si SePuede/TogetherWe CanDo It :DiabetesProgram forHispanics”

EXPORT:$7,100Date: 7/19/06 - 8/06 Minigrant administrator:Carbondale:Bowen GymMulticulturalCommunity CenterCobden:University of Illinois Extension at Cobden

The Bowen Gym Multicultural Community Center(BGMCC) in Carbondale, Jesus es El Señor UnitedMethodist Church (UMC) in Cobden, and St. FrancisXavier Catholic Church in Carbondale, University ofIllinois Extension

Danville “Building communityawareness among Latinos inDanville concerningprimary Health care with anemphasis onOral health”

EXPORT: $4,999Date:11/03/2006Minigrant administrator:Aunt Martha’s Youth ServiceCenter, Inc

University of Illinois Extension –City of Danville HumanRelations Commission, Vermilion County HealthDepartment, School District #118, Danville Area Community College (DACC), Faith-based organizations(i.e. Holy Family Church), Provena United SamaritansMedical Center, Aunt Martha’s Community center

DeKalb “Enhanced HealthServices Program forHispanics”.

EXPORT: $4,500Date: 8/26/2005Minigrant administrator:College of Health andHuman Sciences, NorthernIllinois University

DeKalb Schools, Sycamore Schools, Kishwaukee College,DeKalb County Health Department, KishwaukeeCommunity Hospital, DeKalb Clinic, KishwaukeeMedical Associates, Dr. Joseph Baumgart, St. MaryChurch (DeKalb), Community Coordinated Child Care,Ben Gordon Center, Family Service Agency, AmericanHeart Association, DeKalb County CommunityFoundation, DeKalb County Community Services,Conexion Comunidad, Rep. Robert Pritchard, SenatorBrad Burzynski, University of Illinois Extension forDeKalb County, Tri County Community Health Services,and Northern Illinois University – College of Health &Human Sciences and Center for Latino & Latin AmericanStudies.

Community Minigrant Programs Community Minigrant title Minigrant funds Organizations involved

Effingham “Hablemos de SaludInfantil/Let’s talk aboutChildren’s health: an educationalWorkshops Program regardingchildren’s dental and physicalhealth in general”

EXPORT: $4,500Date: 7/14/06 Minigrant administrator:Helen Matthes Library atEffingham

University of Illinois Extension, HelenMatthes Library, local churches, schooldistrict and community leaders.

Monmouth “Breaking down the languageBarrier in Warren County”

EXPORT: $4,500Date: 11/20/06Minigrant administrator:Western Illinois EconomicDevelopment Partnership

University of Illinois Extension, HendersonMercer Warren Unit. Western IllinoisEconomic DevelopmentPartnership/Prairie Tech Learning CenterCommunity Medical Center Hospital Illinois Department of Commerce andEconomic Opportunity Warren CountyHealth Department (a new organization)The Illinois Coalition for CommunityServices

Rochelle “Communication enhancement toreduce barriers in accessing healthservices for non-English speakingresidents of the Rochelle area”

EXPORT: $4,500Date: 8/30/05 Supplemental funding from RCH:$2,950Minigrant administrator:Rochelle Community Hospital

Rochelle Community Hospital, Head Start,Rochelle HOPE of Rochelle, Rochelle CAN,Sinnissippi Centers, St. Patrick’s Church,University of Illinois Extension-OgleCounty, Tri-County Community NursingService, Ogle County Health Department,Kishwaukee Community college, RochelleTownship High School, Hand in HandCommunity Services, Service organizationsand businesses.

Rockford The Services Access andNavigation Assistance (SANA)Project

EXPORT: $5,000Date: 02/07 Supplemental funding pending Minigrant administrator:La Voz Latina

Rockford Health System, Crusader Clinic,La Voz Latina, Total Health AwarenessTeam (THAT), theWinnebago County Health Department,Swedish American Health System, and theRockford Health Council.

1. Minigrant Program: Leveraging Opportunities by Sources and Types

• Direct Funding to Communities (~$50,000)

• Leveraging Opportunities• (Sources) Directly from community:

• Community foundations, CBO’s, local government• State – Americorps/VISTA, IDPH• Universities - University of IL Extension, UIC, NIU

• (Types) In-kind community contributions:• Volunteerism – release time from orgs for volunteers to attend

meetings, community activities, assist in research activities• Building and meeting activity space• Materials, incentives, food etc

Priorities Identified After Assessment Phase

Communities Community Programs

Language Barriers Rochelle, Beardstown,DeKalb, Belvidere,Carbondale/Cobden,Monmouth, Rockford,Galesburg

Medical InterpretationTraining

Lack of knowledge about“where to go” when health careservices are needed

Rochelle, DeKalb,Monmouth, Galesburg,Belvidere,Carbondale/Cobden

Bilingual Resources Guides– Newsletters

Lack of local health educationalprograms in Spanish

Effingham, Rochelle,DeKalb, Belvidere, DeKalb,Danville, Carbondale/Cobden, Rockford,Monmouth, Galesburg

Health educationalprograms: Workshops andHealth Fairs in Spanishpresented by Hispanicprofessionals

Lack of access preventivescreenings (i.e. eyeexaminations, blood sugar,blood pressure, cholesterol etc)

Belvidere,Carbondale/Cobden,Danville

Use of free and low cost screenings and examinations to assist primarily uninsured community members to diagnose their health conditions.

Lack of access to culturallyappropriate strategies to increaseexercise and improve nutrition

Carbondale/Cobden, Galesburg Fitness programs andcooking classes

Importance of Evaluation

The whole evaluation process has to lead to self-determination. This means that any evaluation process has to be empowering to the stakeholders/community and give them something that benefits them…something that gives them more knowledge about what is happening in the project, the program and/or the community.

Our Perspectives…

• Social programs have become more broad, complex and interactive• Seek to bring about changes in community capacity, social

support, decision-making, control over resources and individual behavior

• Time to supplement traditional strategies with new approaches reflecting complexity of community-based initiatives

• Some evaluators believe communities lack skills to design, engage in and interpret evaluations

• However, ‘experts’ may lack insight/ flexibility needed to capture ‘essence’ of community projects or to answer questions raised by communities, CBOs and other stakeholders

Our Perspectives… (cont’d)

• Community-based evaluation perspective involves more participatory and inclusive process that incorporates the values, knowledge, expertise and interests of the community and uses evaluation as a tool for community capacity building

• Community involved as full/equal partner allows for development of more ‘relevant’ program success measures and produces data that are useful in community settings

Evaluation Phase:

Guiding Questions:

• EXTERNAL: What impacts do local communities have on local efforts to address the issue of health disparity in rural communities? How and Why?

• INTERNAL: What impacts does a university located, grant funded Community Outreach initiative have on national, state and local efforts to address the issue of health disparity in rural communities? How and Why?

Evaluation Phase:

Evaluation Frameworks and Models Used:

• Organizational: (Donabedian, 1966)• Structure Process Outcomes

• Community Comparison Case Stud(ies): (Yin, 1994)• Evaluation of each of the 14 communities

• Impact: REAIM (Glasgow, 1999)• Reach, Effectiveness, Adoption, Implementation, Maintenance

Evaluation Phase:

Evaluation Areas:

1. Hispanic Health Advisory Committee Evaluationa. Structure, Process, Outcome

2. Community Activities and Implementation Effortsa. Individual activitiesb. Individual mini-grant implementation

3. Global Community Impact a. Mini-grant Cluster Evaluationb. Community Oral History Evaluationc. Community Comparative Case Study

Evaluation ProjectsType of Evaluation Communities involved

Hispanic Health Advisory CommitteeEvaluation (n = 76)

Rockford, Belvidere, DeKalb, Rochelle, Danville,Carbondale/Cobden, Beardstown, Effingham,Monmouth, Galesburg

Medical Interpretation training Daily,Final and follow – up evaluations (n= 24)

Beardstown, Rochelle, DeKalb, Belvidere,Carbondale/Cobden

Health educational workshopsevaluation (n = 268)

Belvidere, Rochelle, DeKalb,Carbondale/Cobden, Rockford, Effingham,Danville

Community resources guideEvaluation ( n= 50)

Rochelle, DeKalb

Providers resources guide evaluation (n = 30)

Rochelle, DeKalb

Fitness and nutritional programs (n=7) Carbondale/Cobden

Minigrant evaluations (n = 71) Rockford, Belvidere, DeKalb, Rochelle, Danville, Carbondale/Cobden, Beardstown, Effingham,Monmouth, Galesburg

Community Oral History (n = 10) Rockford, Belvidere, DeKalb, Rochelle, Danville, Carbondale/Cobden, Beardstown, Effingham,Monmouth, Galesburg

Dissemination Phase:• Translational Research Framework

• Translation Research characterizes the sequence of events (i.e., process) in which a proven scientific discovery is successfully institutionalized integrated into established practice and policy. Comprised of dissemination research, implementation research and diffusion research. 

• Dissemination Research is the systematic study of how the targeted distribution of information and intervention materials to a specific public health audience can be successfully executed to increase spread of knowledge.

• Implementation Research is the systematic study of how a specific set of activities and designed strategies are used to successfully integrate an evidence-based public health intervention within specific settings.

• Diffusion Research is the systematic study of the factors necessary for successful adoption by stakeholders and the targeted population of an evidence-based intervention which results in widespread use. 

Community Dissemination Efforts Dissemination Channel Number Communities

Flyers inviting the localcommunity to participate ineducational activities, or healthfairs

Approximately 7,000 flyers havebeen distributed between 2005-2007

Belvidere, Rochelle, DeKalb, Rockford,Effingham, Danville, Galesburg,Monmouth, Carbondale/Cobden, Beardstown,

Community popular reportsSummarizing assessment results toCommunity members(English/Spanish)

Approximately 1,100 popularcommunity reports have beendistributed between 2005-2007

Belvidere, Beardstown, Rockford, DeKalb,Rochelle,

Newspaper articles/News releases Approximately 26 newspaper articleshave been published in localnewspapers and news lettersbetween 2005-2007

Belvidere, Rockford, Monmouth, Galesburg, Rochelle, DeKalb, Danville,Carbondale/Cobden, Beardstown,

Community resourcesguide/community newsletters

Approximately 2,800 copies havebeen distributed among communitymembers between 2005-2007

Rochelle, DeKalb, Monmouth, Galesburg,Carbondale/Cobden

Community health fairs 7 community health fairs andapproximately 850 communitymembers participated in theseevents between 2005-2007

Belvidere, Danville, DeKalb, Monmouth,Galesburg

Informational meetings with localstakeholders

4 informational meetings and approximately 60 local stakeholdersattended these meetings between2005-2007

Rochelle, DeKalb, Beardstown,Carbondale/Cobden,

Implications/Inferences for Health Equity/Social Justice

• Study context is about ‘Community ‘Readiness’ to engage in community based health research partnerships (Freire Stages of Readiness)• Purpose was to develop research models and

community processes to engage in health disparity research efforts

• To explore willingness/ability of rural IL communities to address health disparity issues

Areas of Potential Focus

• Minigrant Funding Program

• Issue-based Categories Contributing to Community Social Justice Impacts in Local Health Sectors • Internal/Individual• External/Health Care System

Minigrant Program: Leveraging Opportunities by

Sources and Types• Direct Funding to Communities (~$50,000)

• Leveraging Opportunities• (Sources) Directly from community:

• Community foundations, CBO’s, local government

• State – Americorps/VISTA, IDPH

• Universities - University of IL Extension, UIC, NIU

• (Types) In-kind community contributions:• Volunteerism – release time from orgs for volunteers to attend

meetings, community activities, assist in research activities

• Building and meeting activity space

• Materials, incentives, food etc

Issue-based Categories Contributing to Community Social Justice Impacts on Local

Health Sectors

Issue-based Categories Contributing to Community Social Justice Impacts in Local Health Sectors

Community Programs Developed

Language Barriers Medical Interpretation Training

Lack of knowledge about “where to go” when health care services are needed

Bilingual Resources Guides - Newsletters

Lack of local health educational programs in Spanish

Health educational programs: Workshops in Spanish presented by Hispanic

professionals covering health problems identified in the assessment process.

Lack of access preventive screenings (i.e. eye examinations, blood sugar, blood

pressure, cholesterol etc)

Use of free and low cost screenings and examinations to assist primarily uninsured

community members to diagnose their health conditions.

Lack of access to culturally appropriate strategies to increase exercise and

improve nutrition

Fitness programs and cooking classes

Some Final Reflections to Communicate: Evidence and PracticePractice and Evidence

• If we want more evidence-based practice, we need more practice-based evidence.

• Recognize the importance of practitioners and other end-users in shaping the research questions.

• Practitioners and their organizations represent the structural links (and barriers) to addressing the important health issues. Engage them.

• Green, LW. From research to “best practices” in other settings and populations. Am J Health Behavior 25:165-178, April-May 2001.

Acknowledgments

• NIH/NCMHD (5 P20 MD000524) – Project EXPORT Center of Excellence in Rural Health

• National Center for Rural Health Professions

• UIC College of Medicine at Rockford

• UI Extension

• Community Health Advisory Committees

Thanks…